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If you broke down that amount into $ per hr, considering the antenatal care as well as being on call for a potentially all day labour, it's probably not an unreasonable fee at all. They likely have insurance to pay as well. I don't think it's covered by medicare tho, and I think only a few health funds cover it? That needs to change too in order for midwives to be used more.
Julie Doula - I LOVE your work... :hug:
Caro: I am not sure who said that obs are greedy - I don't recall reading that. Undoubtedly they are very expensive as is private health insurance. I am a nurse and am fully aware of the HUGE insurance bills faced by obstetricians. I also would like to make a little point.
When you see an obs (trust me over the past couple of years I have seen my share!) it is a quick 10-15 minutes. When you see a professional midwife your visit extends sometimes up to an hour and sometimes more! A doctors visit for that 15 minutes costs around $120 at my obs - with during a 40 week pregnancy requiring perhaps 15 visits that's about $1800. On top of that you have the delivery costs and the insurance costs that are passed on to the client. This is now packaged as a pregnancy maintance fee or some other such wording. My obs charges $2500 for this... Then for a routine delivery the cost is another $1200 so tht takes us up to $5300. Of course the fees will vary between obs and obs and depending on where you are situated. A friend of mine was charged $4000 from a Melbourne obs for her pregnancy maintainence fee. So clearly the fees are high. The fee at my obs will depend on the risk of the delivery. A "complicated" delivery will cost more - having a condition such as GD will mean I am a "complicated delivery" and with this I was charged an extra $500.
An independent midwife will charge a set fee. What she charges will depend again on where she is situated, where you are situated etc. An independent midwife in my area charges approx. $3000 for a birth (including antenatal and postnatal care) The midwife will come to YOUR home and visit you before during and after the birth. She will bring her practice to you. She will spend at LEAST half an hour (often more) with you and talk to you about your joys and fears. She will palpate your baby, talk to your baby, listen to your baby, watch your baby grow safely... She will massage you and get to know your husband and other children. She will refer you on if a dis order rears its head. She will come when you phone her when you are in labour when you need her to. She will stay with you and support you at home or in hospital wherever your preferred birhing place is. The costs involved with this vary from midwife to midwife. However, the cost is less than an obs and the time she will give you is much more.
An obstetrician is a doctor. He treats dis order. His role is to care for women who need medical assistance. As many of the women have said in here THANK GOODNESS that we have access to them if we need them. I personally have never required a doctor for any of my births. (However I do require one now for my pregnancies due to a dis order I have.) Most often an obs will come only when birth is imminent. He/she has many more clients than an independent midwife they simply haven't the time to labour with you or to come to your home.
Someone mentioned not comparing apples with apples. We can't compare midwifery care with obstetric care as they are very different. The charges are different because the service is different. One is treating dis order and one is caring for women during a natural process.
Tara: You had a harrowing experience and I am so sorry :hugs:. There are certainly midwives out there like that, I have come across some too :( . I hope your next birth is all that you want it to be. Choosing a birthing centre with midwives that you can get to know and can get to know you is a wonderful way to get the birth you chooose.
Safe birth is about INFORMED choice. Not choice made from a perspective of fear and not choice made from a perspective of "it won't happen to me". We do need balance as Julie Doula has so beautifully put.
My concern is that women are very often not independently seeking out the truth. Women are fed images from the media about "what goes wrong". We get images of those over the top movie stars that are "too posh to push". We are fed fearful stories by our mothers and grandmothers who often had APALLING birth stories to tell. It was the norm in the 60's and 70's and even in the 80's to be drugged and in stirrups.
We think that we are safer in the hands of a doctor that we will get a better outcome. The stats just don't support that. Statistically you will have a better birth outcome if you are supported through pregnancy and birth by a woman known to you. Women who educate themselves about the birthing process generally care for their bodies, minds and spirits. They read and educate themselves, they connect with other women. This is what we need to have an empowered birth.
Yes, you can have that and still be under the care of an obs. But you need to make some choices. If you are laboruing under the care of an obs you can ask for what you need. I laboured with my last child under the care of an obs but I had my own midwife. I asked that the obs did not enter my birthing space unless there was a medical indicator. I found an obs who would do this. He sat outside and read the paper and ate donuts. I needed to protect my birthing space. That to me is sacred. I made it my own with oils, and candles and music and my children around me. Someone mentioned that to birth we need to replicate the conception space. This is so very true. No one wants to get jiggy with it on a stainlessteel bed. No womb feels like giving up it's baby in a sterile environment. Many new hospitals recognise this and birthing centres where there are lamps and soft furnishings. These things (meaning a homley environment) are incredibly important. OUREHEADS ARE THE MOST IMPORTANT BIRTHING ORGAN. When are head is right so are our cervix's.
Who wants to make love with strangeers watching? Not many of us. The same with birth - we need to have a connection and a relationship with those that are in our birthing space. We need to move freely. We need to vocalise. To squat to swivel to dance to cry...
African women are not the same as white Australian women - Indigenous women face third world conditions too unfortunately in this land of plenty. Women of spirit are bundled off to the stainless steel rooms to birth their babies - often these women have terrible experiences. They don't believe it is "right" to birth away from the land. We can learn an awful lot from our indigenous sisters. They know about instinct and position and about woman love and support. Yes, they need a little help sometimes too just as white australians do but they very often haven't lost their inherited "knowing" about birth.
Someone mentioned that a midwife led birth isn't for everyone. I wonder why that is? Clearly it's not if there is a medical problem. But apart from that I believe that many women don't choose a midwife because they don't really understand what a midwife can do. They have experiences in hospital where a different midwife comes on each shift and you need to get into a new rythum with her. This isn't what is should be like. Birth is a sacred event. It should not be at the whim of a shift change. Women should labour with a midwife that they know. This has been proven to have incredibly good outcomes.
We can learn much from countries such as NZ and even the UK.
We need to ask for what we want. There will always be women who want a medicalised birth. What I fear though is when women make this choice without an educated decision. This decision is often made from a perspective of fear. This troubles me greatly...
Another perspective on the fees - they are that much because the government is not subsidising midwifery choices for birth AT ALL. In NZ you can get midwifery care through medicare. Not here! But you can get claim a podiatrist and other things like that. The govt will not give provider numbers to midwives and until enough people kick up a stink about it not much will change. Private health is pretty bad too, some will cover small amounts, some like Medibank Private not at all - so I cancelled my PHC with them. Midwives do not do as many births as an Ob would, private midwifery is not in huge demand so that 3000$ may be their gross income for the month, ex-tax etc. I am yet to meet a filthy rich midwife driving around in a BMW. :D Its not a job you do for the $$.
Doulas - Anything up to $900 (completely depends on the package +/- visits) in Melbourne for VERY experienced attendants. More in some states. But they serve purposes different to an Ob you cannot compare. They spend around 2 hours at a visit with you. They specifically de-brief with you for about the same time. You wont get an Ob who will sit down with you and ask you how the birth was for you and to share your feelings and talk about it over a cuppa, and help with feeding, settling, light cleaning if needed etc. I see much value in that. A doula will also spend more time with you than anyone. I spend 6 hours in pre/post natal visits and have been with a woman in labour for up to three days. Yes, two nights with no sleep. Another birth was two days and most are 1-2 days. No-one else gives you that except your partner, so we physically work for every cent. Not that we do it for money! Who would work three days straight with no sleep? ;) A doula would LOL. And she would do it at the drop of a hat, usually arranging childcare and no matter what day and time, there is no sick leave, annual leave or super.
I also see much value in an Ob being present during times of complications which a midwife cannot help with. Watching shows like saving babies where there ae premature, sick babies, we are so lucky. But as I always say, I would not go straight to an Ear, Nose and Throat specialist every time I had a bad cold. I'd go to my GP first.
But again, this is not about choices of carer or place of birth, its having those choices in the first place, equally affordable and balanced info. As much as this doco may look unbalanced to you, if you go to a GP, they will not give you brochures on homebirth or midwives along with your private hospital recommendations. In fact some will give you a serve! Equal info for all I say.
One of the reasons Caro that midwives are not covered by medicare is because our system has become so medicalised. Midwives have degrees as do nurses some have doctorates. It is not about education it is about the medicalisation of birth that midwives are not covered by medicare.
Yep insurance has been taken away from them which is hard to understand when they offer care with great outcomes, but as a result they are not given provider numbers and hence why you cant get private care for them. They are close to getting insurance again from a mob in WA, they apparently need 200 midwifery signatories to go ahead and have something in the 190's. Must get an update.
Yes Caro - midwifery led care is much less of a drain on our health budget. Mr Beattie is slowly realising this up here but we have a LONG way to go. There are some happy things on the horizon in the public system in Qld with regard to midwifery models of care.
I dont' know that it is accurate to say "a lot of babies and mothers died". The maternal and infant mortality rates were higher in hospitals and at home in our grandmothers/greatgrandmothers day. That is due to health standards, economy, education and care.
Too Posh to push I believe was first coined by POsh spice. She didn't want her scrawny little hoo haa disturbed!
Kelly - midwives in a Qld hospital here are getting closer to obtaining independent insurance - I will find out more and get back to you on that. It was last a few weeks ago that it was discussed... Things are changing. Bringing in non nurse midwives is a huge start - UQ has it's first intake this year...
Well, in theory we should all be happy it's not covered by medicare, coz otherwise midwifery would be medicalised! ;):
Yes I heard some very good things are happening in QLD :)
My great grandmother lost two babies due to homebirth midwives (in the UK, my family are english). One was drunk and one was dirty. Alan and I were discussing it the other day, he has an ad for a midwife role in the late 1800's I think? The description asked for midwives who were clean and sober.
I don't think they know times have changed LOL.
Not too much information at all Caro - Hoohaas are one of my favourite topics !!!!
There is a lot of fear about how your vagina will be after birth and it's something that many women feel they can't ask other women about. It is a fallacy as you have discovered. My vagina and it's sexual functioning is the same as it was prior to children. Vagina's are made to let babies through. Some women can have problems after an instrumental birth requiring an episiotomy or a tear. But this doesn't make it "baggy" it can make it painful for a time... That brings us to the suture or not to suture debate and that is a whole other thread!
About the too posh to push. I want to say some women need to have a c/section for medical reasons, for psychological reasons... The too posh to push is totally about a very small and select group of women who believe to have a c/section will keep their bodies in better shape...
To use Ina May Gaskin's hysterical example, does a horse's butt go all loose and floppy after it's pooped? The vagina is a stretchy, elastic muscle, its designed to stretch then go back to shape. Just like a horse's butt.
Well, Ive had seven babies pass through, and I'm not getting any complaints ;)
Ha ha, me too........:
Well, Ive had seven babies pass through, and I'm not getting any complaints
I asked DH "is it like chucking peanuts into a cathedral?" after I got back in the saddle after Lexie (3rd vaginal birth in 3 years).......to which he replied "Nope, still a perfect fit"......LOL!
On a more serious note, this discussion/debate makes really interesting reading: thanks ladies! xx
The vagina is a stretchy, elastic muscle, its designed to stretch then go back to shape
So, how come i have a prolapse?? I think i got a faulty woohaa
I believe its a possible complication of the form of intervention you had Yael but I need to need to double check...
ETA:
Damage to the pelvic floor occurs particularly in long second stages of labour, rapid deliveries, forceps or vacuum deliveries, and in the delivery of large infants. Often damage that occurs during pregnancy and childbirth goes unnoticed at the time, with symptoms only becoming evident following menopause. Recent research has revealed that the pelvic muscles are avulsed from their attachment at the actual time of delivery rather than later atrophy as a result of nerve damage.
Prevention of Prolapse
Common sense tells us that we should be able to do something to avoid prolapse. In reality genetic factors may be important and changes in lifestyle may have little impact.
Increasingly women are turning to caesarean section to avoid the damage attributed to natural birth but evidence suggests that pregnancy itself is a factor in subsequent pelvic floor dysfunction. Certainly the avoidance of interventional delivery and pelvic muscle trauma at the time of delivery should be a factor in preventing subsequent dysfunction. Damage may not become evident until the menopause when the loss of connective tissue that occurs at this time places more stress on already compromised ligaments.
Treatment of long term medical conditions and weight reduction can also help. Avoidance of activities such as heavy lifting and manual exertion in patients who have a predisposition to prolapse or other risk factors is also important, especially in the first few months after surgery.
I'm trying to work out if it was the vacuum, or the pushing part
And my mum had a bad prolapse that she had operated on
My obs told me to do pelvic floor exercises - all the time - and i only have myself to blame for being slack..
I'm planning on going all out with them again soon, cos i have such a shocking pelvic floor its not funny!
Wow, genetics was a factor too... I'd say go the exercises asap :)
I never do them wither. Ive honestly done about 30 in my whole life. I'll be sorry when I have an accident every time I sneeze when I'm 50.
ETA I'm doing them right now though, lol.
See, you read about it then you start doing it...:
Ha ha ha!! Hoo Haas and pelvic floors - I do mine at the traffic lights or I'd never remember.
This doco has already done great stuff if it is promting fabulous discussions with fabulous women about how fabulous we are at giving birth and the CHOICES we will stand up for.
:clap:
Absolutely!!!!!!
I'm doing them again now, lol. I need to read this thread every day ;)
That was well said Lulu.
Just as a side....my grandmother had 10 babies, the 9 born at home lived the 1 born in hospital died.
I just need to ask - has anyone got through this thread without doing pelvic floor exercises?
yep! I haven't done any LOL. And I probably did about 5 during my pg when the antenatal class was explaining what they were. hehehehe
I love the bit about the damage done too all us womens HOOHAAs.
I read an article the other day and asked my OB on monday gone, its been researched that absolutely no stretching (sex life affecting damage) will be done by having your baby naturally, most damage is caused by A) carrying your precious bundle continually for 9 months on your pelvic floor and B) NOT doing your pelvic floor exercises......(and nope I too dont do em...)
so really not having a natural delivery to preserve (great word sounds like your making jam with you weewha) your weewha is a load of horse manure...
Oh and theres another mother and baby mag. article called....Vagina free birth....its a good read.
Lindie
I am a pelvic floor nerd. It is sometimes the ONLY excercise I do, LOL! I do them religiously at traffic lights and during the adbreaks on TV........
I must say after 3 kids and tearing and stitches each time I don't feel any different down there either. Sometimes I feel a bit achey but thats it. Must start doing those pelvic floor exercises...
When it comes to looking back to the past in terms of pregnancy and birth I feel we should be careful not to romanticise how things were. The fact is the maternal and neo-natal death rate was much higher then than now. This can be attributed to many reasons, and not necessarily the rise of obstetricians or hospital births, I do appreciate that. But as someone whose first birth was induced due to pre-eclampsia, I also appreciate the fact that had I been pregnant and given birth 100, or even just 50 years ago, I would have faced the very real possibility of me or my baby dying. I am not an advocate of blanket intervention but it definitely has its place.
As for breech birth, I have read comments that the skill of breech birth has been lost over time, but I don't believe that this skill was any more prevalent in our mothers and grandmothers time than it is now. I have no doubt that there were those who could do it but I believe we are lucky now that we have the option of a (clean, sterile) caesarian if our babies are presenting breech. My great grandmother gave birth to her first baby, a son, in the 1920s. We are talking 80 odd years ago. He was breech and in order to birth him, the doctor broke his legs. The baby died. Maybe this was a exeptional case, I don't know. But it makes me feel grateful that I live in the modern world where we can take it for granted that we will have access to clean hospitals and modern medicine.
Thanks to this thread being continuously responded to I've been doing my *exercises* everyday. I haven't had to remind myself, just had to keep reading this thread! lol.
Oh, Bon... that's really, really awful for your great grandmother to experience. I'm appalled and shocked, shaking my head in disbelief!!!
There are still cases now where there are poor outcomes for breech babies, where the doctor or midwife tries to manage them like a normal birth because they do not know how to handle a beech birth (there are so few of them these days). However breech birth requires a hands off approach and allowing the baby to do the work him/herself until the last minute, no maneuvering or anything as if it were head first.
Its not a scary thing, I have been present to a breech birth with one of BB members, which went without a hitch with an Ob who does around 3 a month and is skilled. Anywhere you go, you will get skilled and unskilled doctors or midwives in breech. Where they are not skilled they will want to do a caesarean. Also, some breech positions are more favourable than others. Many will do a caesarean on a footling breech (feet first, as opposed to bum). The hips have around the same diameter as the head.
As per a paper I just read, I agree that these days, the highest standard of care is often confused with the most technically advanced care. They are not the same. Just like c/s rates have risen but so have complications and adverse events.
I just want to add, the documentary sounds like it is following a similar vein to the book "Misconceptions" by Naomi Wolf. A very interesting read, and I would recommend it. It also looks at the experience of pregnancy and birth for women in America, and what is wrong with the hospital obstetric system over there. Although I feel the situation is better here, we do need to be careful that we don't go further down that road in Australia.
You're right, Bon, it's important to make sure we're not going down that road here in Aus. Getting midwives funded by Medicare would be a start!
I have to say I feel a bit sorry for all of you poor women who've had such appalling treatment at the hands of health professionals. I feel so lucky to have had an ob who never shafted me out of the door after 15 mins (in fact while I was in hospital I made him late for his patients 'cause he was chatting to me about schools in the area...) and made me feel like he had nothing better to do than talk to and care for me.
And I heard you can get dodgy pelvic floor muscles just from the pg and not from how the baby comes out. I was so slack, lucky I did prenatal aqua aerobics 'cause that was the only time I ever did them. Nary a leak here though!
As for what your hoohaa might look like, I have to say, since I had a c/s I absolutely HATE the ropy scar that might be hidden in my bikini line but is still clearly visible to me several times a day! I hate the fact that it reminds me I couldn't have the birth I wanted and I hate the fact that it tells me I'm more likely to have about half a dozen problems in my next pg. I'd swap that for a slight change in the nether regions any day...
Oh, and I would have gone with the assumption that it's a bit like stretch marks, some get them, some don't. And they fade over time so don't completely destroy your skin. Although I was lucky there too, no stretch marks... Perhaps my hoohaa will escape unscathed when I have my doula-supported, active vbac!!!
Oh Jennifer... I loved your post.
An old lady once said to me and I can't quote her exactly but : "the scars, the droopy breasts and the marks we have from bearing our children should be worn like a large badge of honour". Here here!